Neurofeedback for ADD/ADHD

American Academy of Pediatrics is recommending Neurofeedback
as a treatment of choice for ADHD

NF-ADHD-image1What is ADD / ADHD?

ADD / ADHD or attention deficit hyperactivity disorder is a biological, brain based condition that is characterized by poor attention and distractibility and/or hyperactive and impulsive behaviors. It is one of the most common mental disorders that develop in children. If left untreated, ADHD can lead to poor school/work performance, poor social relationships and a general feeling of low self esteem.

ADHD is often first detected when a child enters school. Attention and behavior issues become more obvious in this structured setting. The student may have trouble sitting still or waiting his turn. His impulsive behaviors may lead him to “act before thinking”. His short attention span and distractibility become more noticeable.

It was once believed that ADHD was exclusively a childhood disorder that was outgrown during adolescence. It is now known that these symptoms can continue into adolescence and adulthood.

Symptoms of hyperactivity and impulsiveness may decrease somewhat during adolescence and be replaced with feelings of restlessness. Attention problems often persist and may manifest itself in different ways. Time management and organization are often difficult. Planning ahead, finishing work, staying on track, organizing activities, following conversations, maintaining relationships — all may required intense effort.

ADHD Symptoms
The most prevalent symptoms of ADD / ADHD are inattention and distractibility and/or hyperactive and impulsive behaviors. Difficulties with concentration, mental focus, and inhibition of impulses and behaviors are chronic and pervasive and impair an individual’s daily functioning across various settings — home, school or work, in relationships, etc.

Symptoms are typically seen early in a child’s life, often when he or she enters a school setting. In order to meet the diagnostic criteria for ADD/ADHD symptoms must be more excessive than what would be appropriate for an individual’s age and developmental level. Problematic behaviors associated with ADD/ADHD may continue into adolescence and adulthood. The Diagnostic and Statistical Manual of Mental Disorders identifies three major symptoms for the diagnosis of ADHD.

Individuals who are inattentive have difficulty staying focused and attending to mundane tasks. Irrelevant sights easily distract them and sounds, shift from one activity to another, and seem to get bored easily. They may appear forgetful and even spacey or confused as if “in a fog.” Organizing and completing tasks is often extremely difficult, as is sorting out what information is relevant versus irrelevant. An individual with inattentive symptoms may have great difficulty keeping up with items, frequently losing things and living life in a disorganized way. Time management is also often an issue. Inattentive behaviors are sometimes overlooked because they are often harder to identify and less disruptive than hyperactive and impulsive symptoms. An individual with the predominately inattentive type of ADHD may even appear sluggish, lethargic and slow to respond and process information.

Individuals who are hyperactive have excessively high levels of activity, which may present as physical and/or verbal over activity. They may appear to be in constant motion, perpetually “on the go” as if driven by a motor. They have difficulty keeping their body still — moving about excessively, squirming or fidgeting. Individuals who are hyperactive often feel restless, may talk excessively, interrupt others, and monopolize conversations not letting others get in a word. It is not unusual for an individual with hyperactive symptoms to engage in a running commentary on the activities going on around them. Their behaviors tend to be loud and disruptive. This difficulty regulating their own activity level often creates great problems in social, school and work situations.

Individuals who are impulsive have trouble inhibiting their behaviors and responses. They often act and speak before thinking, reacting in a rapid way without considering consequences. They may interrupt others, blurt out responses, and rush through assignments without carefully reading or listening to instructions. Waiting turns and being patient is extremely difficult for someone who is impulsive. They prefer speed over accuracy and so often complete tasks quickly, but in a careless manner. They go full swing into situations and may even place themselves in potentially risky situations without thought. Their lack of impulse control can not only be dangerous, but can also create stress in school/work and in relationships with others. Delayed gratification or waiting for larger rewards is very hard for an impulsive person.
Three Types of ADHD are identified:

  • ADHD, Combined Type – Individual displays both inattentive and hyperactive/impulsive symptoms.
  • ADHD, Predominantly Inattentive Type – Symptoms are primarily related to inattention. Individual does not display significant hyperactive/impulsive behaviors.
  • ADHD, Predominantly Hyperactive-Impulsive Type – Symptoms are primarily related to hyperactivity and impulsivity. Individual does not display significant attention problems.

Related Conditions
As many as one third of children with ADHD have one or more coexisting conditions. The most common of these are behavioral problems, anxiety, depression, learning and language disabilities. Adults with ADHD show an even higher incidence of additional or accompanying disorders. These adults may also suffer from depression, mood disorders, substance addictions, anxiety, phobias or behavioral problems. Read more about related conditions.

What are the causes of ADHD?
The exact cause of ADHD has not been determined. However, ADHD is thought to have a genetic component, as it tends to occur among family members. Close relatives of people with ADHD have about a 5 times greater than random chance of having ADHD themselves, as well as a higher likelihood for such common accompanying disorders as anxiety, depression, learning disabilities, and conduct disorder. An identical twin is at high risk of sharing his twin’s ADHD, and a sibling of a child with ADHD has about a 30% chance of having similar problems. Read more about the inheritability of ADHD.

Boys are three times more likely to be diagnosed with ADHD as children, though this ratio seems to even out by adulthood. It is likely that girls are sometimes overlooked when diagnosing ADHD. Symptoms of ADHD can present differently in females, but doctors and other healthcare professionals are becoming better at recognizing, diagnosing and treating girls and women with ADHD.

Ongoing studies are focusing on identifying genes that may cause a person to be more susceptible to ADHD. Research continues to study the link between ADHD and brain structure, brain chemistry especially related to the neurotransmitters dopamine and norepinephrine (which regulate attention and activity), and differences in function of parts of the brain that affect attention and impulse control.

For some individuals, ADHD is the result of early head trauma and brain injury or other impediment to normal brain development such as prenatal exposure to cigarette smoke, alcohol or harmful drugs, premature delivery, birth complications, or exposure to toxic levels of lead. Children with epilepsy are also at a higher risk for symptoms of ADHD.

There is more clarity on what does not cause ADHD. It is not the result laziness or lack of motivation and discipline. Poor parenting, poor teaching, too much television do not cause it, or too much time spent on fast paced video or computer games — though these factors may certainly worsen ADHD symptoms.

It has been suggested that refined sugars, gluten or food additives may increase the risk of ADHD. Nutrition and diet can affect mood and behavior, as well as brain development in early life.

Difference Between ADD and ADHD
Attention deficit disorder (ADD) is a general term frequently used to describe individuals that have attention deficit hyperactivity disorder without the hyperactive and impulsive behaviors. The terms ADD and ADHD are often used interchangeably for both those who do and those who do not have symptoms of hyperactivity and impulsiveness.

Attention deficit hyperactivity disorder (ADHD) is the official name used by the American Psychiatric Association, and it encompasses hyperactive, impulsive, and/or inattentive behaviors. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) actually includes three different types of ADHD.

ADHD, Predominantly Inattentive Type
Symptoms are primarily related to inattention. The individual does not display significant hyperactive/impulsive behaviors.

Most people refer to the predominantly inattentive type of ADHD simply as ADD. These individuals may have trouble paying attention, finishing tasks, or following directions. They may also easily become distracted; appear forgetful, careless and disorganized; and frequently lose things.

Individuals with the predominately inattentive types of ADHD are not hyperactive, they can tend to be rather sluggish and slow to respond and process information. They often have difficulty sifting through relevant and irrelevant information. They may seem day dreamy, spacey or as though they are in a fog and may be shy or withdrawn. Their symptoms are less overt compared to an individual with hyperactive and impulsive symptoms. Unfortunately, as a result, many individuals with the predominately inattentive type of ADHD are often overlooked.

ADHD, Predominantly Hyperactive-Impulsive Type
Symptoms are primarily related to hyperactivity and impulsivity. Individuals do not display significant attention problems.

Those with the predominantly hyperactive-impulsive type of ADHD may appear restless, fidgety, overactive and impulsive. They “act before thinking” and often “speak before thinking” by blurting out and interrupting others. People with these hyperactive/impulsive behaviors may play and interact loudly. They have difficulty staying in their seat, talk excessively, and have trouble waiting turns. They may seem to be perpetually “on the go.”

ADHD, Combined Type
Individuals display both inattentive and hyperactive/impulsive symptoms.

Once an ADHD type is determined, proper treatment approaches can be explored.

Misconceptions and Myths About ADHD

Myth #1: ADHD Is Not a Real Disorder
ADHD is recognized as a disorder/disability by the Centers for Disease Control, the National Institutes of Health, the United States Congress, the Department of Education, the Office for Civil Rights, the American Medical Association, and every other major professional medical, psychiatric, psychological and educational association or organization. Part of the misunderstanding about ADHD stems from the fact that no specific test can definitively identify ADHD. A doctor cannot confirm the diagnosis through laboratory tests as they can other medical diseases such as diabetes. Though there is not yet a specific medical test for diagnosing ADHD, clear and specific criteria must be met for a diagnosis to be made. Using these criteria and an in-depth history and detailed information about behaviors, a reliable diagnosis can be made. An additional misconception may occur because symptoms of ADHD may not always seem clear-cut. We all experience problems with attention and focus to some degree. For an individual with ADHD, however, these symptoms are so severe that they impair daily functioning. ADHD represents an extreme on a continuum of behaviors. Sometimes the behaviors are misunderstood. Symptoms of ADHD can certainly appear similar to other conditions. That is why the health professional making the diagnosis must first rule out any other pre-existing conditions or causes for the symptoms.

Myth #2: ADHD Is Caused by Poor Parenting
This myth has often created negative feelings of self blame in parents of children with ADHD. It is simply not true that poor parenting causes ADHD. What is true, however, is that positive parenting with clear and consistent expectations and consequences and a home environment with predictable routines can help manage symptoms of ADHD. Conversely, a home setting that is chaotic or parenting that is punitive and critical can worsen symptoms of ADHD. Click on Article: Causes of ADHD and Video: Causes of ADHD to learn more.

Myth #3: Only Children Can Have ADHD
Though the symptoms of ADHD must be present by age 7 in order to meet the criteria for diagnosis, many individuals remain undiagnosed until adulthood. For some adults, a diagnosis is made after their own child is diagnosed. As the adult learns more and more about ADHD, he or she recognizes the ADHD traits in themselves. They may think back to their own childhood and recall the struggles in school and problems with attention that were never treated. It is often a huge relief to finally understand and put a name to the condition causing the problems. Thirty percent to 70 percent of children with ADHD continue to exhibit symptoms into adulthood. Often times, the hyperactive behaviors common with children decrease with age, but symptoms of restlessness, distractibility, and inattention continue. Left untreated adult ADHD can create chronic difficulties with work and in relationships and can result in secondary issues such as anxiety, depression and substance abuse.

Myth #4: You Have to Be Hyperactive to Have ADHD
This myth has lead to a lot of confusion about ADHD. Even the name of the condition itself — Attention Deficit Hyperactivity Disorder — leads to misunderstanding. There are actually three different types of ADHD: the predominately hyperactive-impulsive type, the predominately inattentive type, and the combined type. The predominately inattentive type does not include symptoms of hyperactivity at all. Because of this, it is often referred to simply as ADD. An individual with the inattentive symptoms may present as daydreamy and easily distracted, disorganized, forgetful, careless. The predominately inattentive type of ADHD is much less disruptive to others around the individual. So it often gets overlooked, but it is no less stressful for the individual. It is also important to point out that adults with ADHD may lose some of the hyperactive behaviors that may have been present in childhood. Instead the hyperactivity is replaced with a sense of restlessness. Click on ADD verses ADHD to read more.

Myth #5: Use of Stimulant Medications Leads to Drug Abuse and Addictions
Research has actually found the opposite result. If left untreated, individuals with ADHD are at a higher risk of substance abuse. This is likely because secondary problems (such as anxiety or depression) develop from the untreated ADHD and the individual uses the illicit substances to help relieve the ADHD symptoms. It becomes a way of self medicating, though it is obviously not effective. For those who receive appropriate treatment, which often does include stimulant medications, the rate of substance abuse is much lower.

Myth #6: If You Can Keep Focused on Some Activities, You Do Not Have ADHD
It can be quite confusing to see someone with ADHD focus intently on an activity when ADHD seems to be an “attention deficit.” It is actually more appropriate to describe ADHD as a condition in which individuals have difficulty regulating their attention. Though they may have extreme problems focusing, organizing, and completing certain mundane tasks, they are often able to focus intently on other activities that interest and engage them. This tendency to become absorbed in tasks that are stimulating and rewarding is called hyperfocus. Click on Hyperfocus and ADHD to learn more.

Myth #7: Medication Can Cure ADHD
Medications do not cure ADHD rather they help to control symptoms of ADHD on the day they are taken. ADHD is a chronic condition that does not go away, though symptoms may change or lessen over time. Many individuals develop coping and organizing strategies to help manage and control symptoms over their lifetime. Some individuals continue to need medical treatment through medications to help control their symptoms into adulthood.

Myth #8: ADHD is Over-Diagnosed
It’s hard to know for certain whether or not ADHD is over-diagnosed. Many believe that the inattentive type of ADHD is actually under-diagnosed because symptoms are less disruptive and overt and are easily overlooked. So there is certainly the possibility that many individuals with ADHD who are missed altogether — not diagnosed and not treated, often developing serious secondary problems related to the ADHD. As a result, they struggle and suffer silently through life not knowing that daily functioning can significantly improve with proper treatment. Some people may jump to the conclusion that every child or adult who displays hyperactive, impulsive or inattentive and disorganized behaviors must have ADHD; however this would be an inaccurate assumption to make. There may be a number of reasons why an individual displays these symptoms including trauma, depression, anxiety, learning disabilities, hearing or vision problems, etc. This is why it is so important for healthcare professionals to conduct careful and thorough evaluations to rule out alternative causes or conditions that may be leading to the problematic behaviors so that diagnoses are accurate and treatment is appropriate.